SURGICAL TREATMENT OF TESTICULAR GERM CELL TUMORS IN CHILDREN, ADOLESCENTS AND YOUNG ADULTS: ANALYSIS ON 52 CASES.
Claudio Spinelli, Professor, Silvia Strambi, MD, Alessandra Pellegrini, MD, Concetta Liloia, MD, Costanza Martelli, MD, Jessica Piscioneri, MD, Andrea Mogorovich, MD.
University of Pisa, Pisa, Italy.
BACKGROUND: Testicular germ cell cancer accounts for approximately 1-2% of malignant neoplasms and represent the most common solid tumor in men between 15 and 39 years of age. Its incidence has increased over the last 40 years but its prognosis is significantly improved. Surgery is the mainstay therapy for its treatment. Early diagnosis, aided by self-examination, is the basis of its excellent prognosis. The purpose of the study is to correlate the clinical, therapeutic and outcome data of two distinct age groups of patients with testicular germ cell tumors.
METHODS:We analyzed 52 patients who underwent surgery from 2009 to 2015 for testicular germ cell tumor, ranging from 6 month to 39 years of age. Patients were divided according to age, in a Group A (0.5-14 years old) and a Group B (15-39 years old), according to Bleyer A et al (J Pediatr Hematol Oncol. 2015) and DeRouen MC et al (J Adolesc Young Adult Oncol. 2016).
RESULTS:Group A covered 12 patients (23%), while Group B 40 patients (77%). Mean age was 28 years. 2 patients (3.8%) had family history of testicular cancer, while one patient (1.9%) suffered from cryptorchidism. The most common clinical presentations were a testicular lump in 42 cases (80.7%) or whole testis volume increase in 10 patients (19.3%); 2 patients (3.8%) presented lymph node metastases, one patient (1.9%) respiratory symptoms (wheezing, coughing, chest tightness) and 2 patients (3.8%) ongoing back pain. Tumor markers were expressed in 23 cases (44.2%).
Inguinal orchiectomy was performed in all cases, with a retroperitoneal lymph node dissection in 16 patients (31%) (10 were synchronous and 6 metachronous, between 12 and 18 months after surgery). A testicular prosthesis was placed in 27 patients (52%). Histopathological examinations revealed 26 (50%) typical seminomas (among which 2 in group A and 24 in Group B) and 26 (50%) non-seminomas (10 in group A and 16 in group B). Patients were treated depending on the clinical stage. In Group A: 11 cases (91.6%) surveillance-only; 1 case (8.3%) underwent chemotherapy (CT)+ radiotherapy (RT)+ retroperitoneal lymphadenectomy (RPLND); among Group B: 23 cases (57.5%) with stage I, 0 or IS underwent surveillance-only; 12 cases (30%) - CT: with stage II or III; 1 case (2.5%) with stage I was treated with local RT; RT + CT was performed in 4 cases (10%) with stage I/II/III. Overall survival at 5 years was 100%, with 93.3% patients free of disease.
CONCLUSIONS: The correlation between the two age groups showed in group A a statistically significant difference only for non-seminoma histology and for low-stage disease. In both groups we observed a good prognosis, confirming this tumor as a "treatable neoplasia".
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